Background
Smoking has been associated with worse colorectal cancer patient survival and may potentially suppress the immune response in tumor microenvironment. We hypothesized that the prognostic association of smoking behavior at colorectal cancer diagnosis might differ by lymphocytic reaction patterns in cancer tissue.
Methods
Using 1,474 colon and rectal cancer cases within two large prospective cohort studies (Nurses’ Health Study and Health Professionals Follow-up Study), we characterized four patterns of histopathologic lymphocytic reaction, including tumor-infiltrating lymphocytes (TIL), intratumoral periglandular reaction, peritumoral lymphocytic reaction, and Crohn’s-like lymphoid reaction. Using covariate data of 4,420 incident colorectal cancer cases in total, inverse probability weighted multivariable Cox proportional hazards regression model was conducted to adjust for selection bias due to tissue availability and potential confounders, including tumor differentiation, disease stage, microsatellite instability status, CpG island methylator phenotype, long interspersed nucleotide element-1 methylation, and KRAS, BRAF, and PIK3CA mutations.
Results
The prognostic association of smoking status at diagnosis differed by TIL status. Compared with never smokers, the multivariable-adjusted colorectal cancer-specific mortality hazard ratio for current smokers was 1.50 [95% confidence interval (CI), 1.10-2.06] in tumors with negative/low TIL, and 0.43 (95% CI, 0.16-1.12) in tumors with intermediate/high TIL (two-sided Pinteraction = .009). No statistically significant interactions were observed in the other patterns of lymphocytic reaction.
Conclusions
: The association of smoking status at diagnosis with colorectal cancer mortality may be stronger for carcinomas with negative/low TIL, suggesting a potential interplay of smoking and lymphocytic reaction in colorectal cancer microenvironment.